Business KYC – Sesiro Insurance Co,

Submit Business KYC

Please use the below latest form for Business KYC

CORPORATE IDENTITY

Company Name *

Income Tax Number

VAT Registration Number (if applicable)

Email Address *

Website

Phone *

Fax *

Physical Address

Unit

City

Country

Botswana Citizen / Permanent Resident?

Postal Address

Nationality

REGULATORY INFORMATION

Certiﬁcate of Registration No.: *

Country of Incorporation *

License no.

Expiry Date

CONTACT PERSON

Prefix

First Name

Middle Name

Last Name

Capacity / Position

Plot Number

Ward /Locality

City

Postal Address

Country

Date of Birth

Nationality

National ID /Passport Number *

Email Address *

Phone *

Fax Number

Brief description of business

Source of income

Annual Turnover *Below P1MillonAbove P1Millon

BENEFICIAL OWNERSHIPDECLARATION OF BENEFICIAL OWNERSHIP The Company hereby confirms and declares that as at the date hereof,The following individual(s) is/are the ultimate principal beneficial owner(s) of the Company through ownership in the intermediate or ultimate holding companies:

Prefix

First Name *

Middle Name

Last Name *

Residential Address

Date of Birth *

Nationality

Ownership (%)

BANKING DETAILS

Bank

Account Number *

Branch *

Branch Code *

DETAILS OF YOUR COMPANY’S BOARD OF DIRECTORSPlease list below the following details of your company’s Board of Directors, clearly specifying where this information is derived from . Provide documentary evidence or weblinks as appropriate:

Director’s Name

Designation

Source of this information

Director’s Name

Designation

Source of this information

Director’s Name

Designation

Source of this information

DETAILS OF KEY MANAGEMENTPlease provide the below details of your Key Management:

Name

Designation

Nationality

Name

Designation

Nationality

Name

Designation

Nationality

DECLARATION OF BENEFICIAL OWNERSHIPThe Company hereby confirms and declares that as at the date hereof, the following individual(s) is/are the ultimate principal beneficial owner(s) (olds more than 10% shares, voting rights or other ownership interests) of the Company through ownership in the intermediate or ultimate holding companies:

Full Name

Residential Address

Date of Birth

Day

Month

Year

Nationality

Percentage of ownership (%)

Full Name

Residential Address

Date of Birth

Day

Month

Year

Nationality

Percentage of ownership (%)

Full Name

Residential Address

Date of Birth

Day

Month

Year

Nationality

Percentage of ownership (%)

DECLARATION

ANTI-MONEY LAUNDERING AND COUNTER TERRORIST FINANCING REQUIREMENTS

n accordance with the Financial Intelligence Regulations, the following documents should be provided for verification:

Natural Persons
Identification document e.g. Certified copy of I.D / Passport

Company
Certificate of incorporation
Memorandum and Articles of Association
Notice of Registered Office and Postal Address
Identification documents of the person(s) managing the company
Resolution specifying who is authorised to act on behalf of the company
Identification document(s) of the person(s) authorised to act on behalf of the company

Partnerships
Partnership agreement
Identification documents of the natural persons who are partners e.g. Certified copy of I.D / Passport
Resolution specifying who is authorised to act on behalf of the partnership
Identification document(s) of the person(s) authorised to act on behalf of the partnership

The following documents must be submitted for all entities:

Notice of registered address *

No file chosen

(CIPA extract/Title deed/Utility Bill)

Bank Confirmation Letter *

No file chosen

Tax registration/clearance/exemption *

No file chosen

First Name

Last Name

Designation *

Date *

Place

OR download the attached form and complete for Business KYC submission

KYC Individual

1 file(s) 104.64 KB

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